(Kit Doyle ~ Columbia Daily Tribune)
It's a debate that has resurfaced from time to time during the last several decades. In recent years, the practice has come under fresh scrutiny from activists armed with research challenging the government's claim that ingesting fluoride is a safe way to control tooth decay. Among the studies are some linking excessive fluoride intake with adverse effects on public health, such as an increased likelihood of bone fractures or linking the ingestion of fluoridated water to lower IQ among children.
Prompted by a group of residents who have been publicly calling for an end to fluoridation, the Columbia City Council has asked the Columbia Board of Health to research the issue and make a recommendation.
"It warrants a second look to see if ingesting fluoride is really the best way to go at this," said Sixth Ward Councilwoman Barbara Hoppe, who drinks bottled water that does not contain fluoride.
Some fluoride opponents, including Columbia resident Bruce Summers, who spoke against fluoridation at a council meeting this month, take issue with the fact the government is administering a medication through public water without consumers' consent and without controlling the dosage.
"Could you imagine a doctor suggesting that we add vitamin D or iron or even aspirin to the water supply?" Summers asked the council. "They'd lose their medical license."
City officials have taken a neutral stance on the issue. If the city council decides the public's drinking water should be fluoride-free, administrators say the roughly $50,000 spent on it each year could easily be spent elsewhere.
But supporters of fluoridating public water -- including the U.S. Centers for Disease Control and Prevention, the American Dental Association and the World Health Organization -- maintain that appropriate levels of fluoride in public drinking water have positive effects on public health. Some organizations argue that removing fluoride from water could disproportionately affect low-income families who cannot afford proper dental care. The CDC even says fluoridating public drinking water was one of the most significant contributions to public health in the 20th century.
Fears about fluoridating public water were famously lampooned in the 1964 film "Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb," in which a U.S. general has gone rogue from his country and remarks that he felt "fatigue" and "emptiness" during an act of "physical love."
The general chalked it up to Soviets putting fluoride in the drinking water, which he called a "monstrously conceived" plot to pollute Americans' bodies. The plot takes aim at real-life 1950s propaganda spread by anti-communist groups claiming that water fluoridation was part of a secret plot to make Americans docile and easier to control.
Jeffrey Pasley, an associate history professor at the University of Missouri who has taught a course on conspiracy theories, said water fluoridation concerns have evolved to "mimic serious social cause advocacy" but still maintain the basic hallmarks of classic conspiracy theories -- namely mistrust of large institutions and fears about what's in the water.
"It's easy to get people cranked up about this notion that there are poisonous substances in your water," he said.
But anti-fluoridation activities say that early fear- mongering about the evils of fluoridation are doing a disservice today for those working to better inform the public about what they are drinking. Paul Connett is an environmental chemistry professor at St. Lawrence University in Canton, N.Y., and director of the Fluoride Action Network, an international group that seeks to raise awareness about fluoride. Talk of Strangelove and tinfoil hats by journalists and those who support fluoridation makes him want to "explode," he said.
Connett co-authored a 2010 book titled "The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There." In the two years since, he said, he has not seen a "serious scientific critique" of the claims he and two other researchers presented in the book. Instead, fluoridation proponents seem to reach for the argument that the CDC considers fluoridation a boon to public health.
"This is utter nonsense, but they get away with it," Connett said. "They get away with it because they, quote, have the authority."
In a report released in 1999, the CDC said it considered water fluoridation to be one of the top 10 contributions to public health in the 20th century. That same report said no subsequent research supported association between fluoride and increased risks of cancer, Down syndrome, bone fracture, Alzheimer's disease or other health conditions. To support the claim, the report's author cited a study from 1993, six years before the CDC report was released.
Connett said if he used material six years out of date to support his anti-fluoride claims, "I would be crucified."
He also points to a 2006 study from the National Research Council about the effects of high levels of fluoride in drinking water. At 4 parts per million -- the maximum allowed by the U.S. Environmental Protection Agency -- children could be at increased risk for dental fluorosis, a disorder that affects the way enamel develops and can cause spots on teeth. The same report also says that level of fluoride could cause weakened bone structures and lead to bone fractures.
In 2011, the U.S. Department of Health and Human Services recommended the amount of fluoride in public drinking water systems be lowered from a maximum of 1.2 parts per million to a maximum of 0.7 parts per million, which is the level found in Columbia's drinking water. Of that amount, about 0.3 parts per million of fluoride is naturally occurring.
Fluoridation opponents often cite this change as evidence that the government is acknowledging the dangers of fluoridated water. But supporters, including Lori Henderson, a local pediatric dentist, say that the recommendation takes into account the fact there are more fluoride sources, such as toothpastes and mouth rinses, available today than when the original recommendation was set.
Since 2010, the year Connett's book was published, 79 cities in the United States, Australia, Canada and New Zealand have eliminated fluoride from drinking water, according to the Fluoride Action Network's website. The website notes that 97 percent of western European countries do not fluoridate public water, but many of those countries add fluoride to table salt.
In Missouri, cash-strapped Pevely, which is south of St. Louis, decided this year to stop fluoridating its water to save money. In O'Fallon, which stopped putting fluoride in public water in 2010, officials touted the end of the practice as a way to save money and enhance worker safety. Earlier this year, St. Joseph's city council cast a split vote in favor of continuing to fluoridate its water.
Columbia has been fluoridating its public drinking water since 1973.
The Columbia Board of Health is expected to discuss fluoridation at its Jan. 10 meeting. Board member Colin Malaker, a local dentist, said he is still researching the issue. As a libertarian, he said he has issues with the administration of fluoride through public water but doubts governmental and health agencies are lying to the public when they claim appropriate levels are safe.
Either way, Malaker said, no amount of fluoride in the public water supply will make up for basic oral hygiene when it comes to fighting tooth decay.
"You could fluoridate the water all day long," he said. "If you don't brush your teeth, it isn't going to work."